Skyline Pediatric Dentistry LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

SKYLINE PEDIATRIC DENTISTRY LLC

Practice address

1405 N 205TH St
Suite 100
Elkhorn, NE 68022-4740

Phone

(402) 289-1574

NPI assigned

Jan 19, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Vincent Rothe

Title

Owner

Phone

(402) 289-1574

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326931200000",
    "number": "1699046847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 N 205TH ST",
            "address_2": "SUITE 100",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680224740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 N 205TH ST",
            "address_2": "SUITE 100",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680224740",
            "telephone_number": "402-289-1574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKYLINE PEDIATRIC DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-19",
        "last_updated": "2012-01-19",
        "status": "A",
        "authorized_official_last_name": "ROTHE",
        "authorized_official_first_name": "VINCENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-289-1574"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025787700",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelsi Simpson, M.S. CF-SLP
• Mickaela Simpson
• Cheryl Skalla
• Skin PC
• Skyline Medical Center, P.C.
• Skyline Vision Care, LLC
• Erin Alise Sloup, PA-C
• Kaylee Kristine Smalley, LIMHP
• Lauren Smeal
• Audrey Caroline Smith

• Pediatric Dentistry in Elkhorn, NE
• Providers in Elkhorn, NE by specialty
• Pediatric Dentistry in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.